Health Insurance: Paying By The Pound?
I'm all for it. And by the cigarette, too. Or, look at it another way, discount health insurance to non-smoking, non-obese people like me. From a New York Times Magazine article, "The Fat Tax," by David Leonhardt:
Michael McGinnis, a senior scholar at the Institute of Medicine, has estimated that only 10 percent of early deaths are the result of substandard medical care. About 20 percent stem from social and physical environments, and 30 percent from genetics. The biggest contributor, at 40 percent, is behavior.Today, the great American public-health problem is indeed obesity. The statistics have become rote, but consider that people in their 50s are about 20 pounds heavier on average than 50-somethings were in the late 1970s. As a convenient point of reference, a typical car tire weighs 20 pounds.
This extra weight has caused a sharp increase in chronic diseases, like diabetes, that are unusually costly. Other public-health scourges, like lung cancer, have tended to kill their victims quickly, which (in the most tragic possible way) holds down their long-term cost. Obesity is different. A recent article in Health Affairs estimated its annual cost to be $147 billion and growing. That translates into $1,250 per household, mostly in taxes and insurance premiums.
A natural response to this cost would be to say that the people imposing it on society should be required to pay it. Cosgrove mentioned to me an idea that some economists favor: charging higher health-insurance premiums to anyone with a certain body-mass index. Harsh? Yes. Fair?
The Cleveland Clinic guy at the beginning does make the typical error about what causes people to gain and lose weight -- assuming it wasn't paraphrased wrong by Leonhardt:
People's weight is a reflection of how much they eat and how active they are.
According to Gary Taubes' exhaustive reporting, detailed in Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health, it's sugar, flour, and easily digestible starches like potatoes that make us fat. These foods cause insulin levels to rise. When insulin levels rise, we stockpile calories as fat. Eating foods with very low (or no) carbs -- meat, fish, poultry, cheese, eggs, butter, and non-starchy veggies -- decreases appetite and increases fat loss and weight loss.
Exercise doesn't seem to be the weight loss tool it's cracked up to be, either. Taubes writes about this in New York Magazine -- that one of the main problems with exercise is that it makes you hungry:
Just as sweating makes us thirsty, burning off calories makes us hungry.This research has never been controversial. It's simply been considered irrelevant by authorities, all too often lean, who have been dead set on blaming fatness on some combination of gluttony, sloth, and perhaps a little genetic predisposition thrown in on the side. But contemplating the means by which we might lose weight without considering the hormonal regulation of fat tissue is like wondering why children grow taller without considering the role of growth hormones. Or, for that matter, like trying to explain the record-breaking triumphs of modern athletes -- Barry Bonds, say -- and never considering the possibility that steroid hormones (or human growth hormone or insulin) might be involved.
If it's biology, and not a lack of willpower, that explains why exercise fails so many of us as a weight-loss tool, then we can still find reason for optimism. Since insulin is the primary hormone affecting the activity of LPL on our cells, it's not surprising that insulin is the primary regulator of how fat we get. "Fat is mobilized [from fat tissue] when insulin secretion diminishes," the American Medical Association Council on Foods and Nutrition explained back in 1974, before this fact, too, was deemed irrelevant to the question of why we gain weight or the means to lose it. Because insulin determines fat accumulation, it's quite possible that we get fat not because we eat too much or exercise too little but because we secrete too much insulin or because our insulin levels remain elevated far longer than might be ideal.
To be sure, this is the same logic that leads to other unconventional ideas. As it turns out, it's carbohydrates -- particularly easily digestible carbohydrates and sugars -- that primarily stimulate insulin secretion. "Carbohydrates is driving insulin is driving fat," as George Cahill Jr., a retired Harvard professor of medicine and expert on insulin, recently phrased it for me. So maybe if we eat fewer carbohydrates -- in particular the easily digestible simple carbohydrates and sugars -- we might lose considerable fat or at least not gain any more, whether we exercise or not. This would explain the slew of recent clinical trials demonstrating that dieters who restrict carbohydrates but not calories invariably lose more weight than dieters who restrict calories but not necessarily carbohydrates. Put simply, it's quite possible that the foods -- potatoes, pasta, rice, bread, pastries, sweets, soda, and beer -- that our parents always thought were fattening (back when the medical specialists treating obesity believed that exercise made us hungry) really are fattening. And so if we avoid these foods specifically, we may find our weights more in line with our desires.
John Cloud echoed this recently in TIME:
Some research has found that the obese already "exercise" more than most of the rest of us. In May, Dr. Arn Eliasson of the Walter Reed Army Medical Center reported the results of a small study that found that overweight people actually expend significantly more calories every day than people of normal weight -- 3,064 vs. 2,080. He isn't the first researcher to reach this conclusion. As science writer Gary Taubes noted in his 2007 book Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health, "The obese tend to expend more energy than lean people of comparable height, sex, and bone structure, which means their metabolism is typically burning off more calories rather than less."In short, it's what you eat, not how hard you try to work it off, that matters more in losing weight. You should exercise to improve your health, but be warned: fiery spurts of vigorous exercise could lead to weight gain.
Finally, one other really terrific book on the subject -- a companion book to Taubes', with more direct information on diet, and an easier read -- The Protein Power Lifeplan, by Drs. Michael and Mary Dan Eades. A blog post by Michael Eades here. Be sure you check out the YouTube video at the end.
Amy, you make a lot of comments about how evil carbs are but I had an 18.5 BMI on a high-carb diet. Exercise does make a huge difference, because it burns the carbs that you consume. I just want to make sure there aren't any potential endurance athletes (marathoners, cyclists, etc) who read your post and are seriously considering going low-carb, because that lifestyle only works for non-athletes.
To your credit, most Americans do eat too many refined carbs and this does help make them fat, but it's not as though one can make a blanket statement that eating carbs = obesity.
Clare at August 15, 2009 4:53 AM
I never lost weight through exercise (even when I've tried), just gained muscle. I did do it to GAIN weight though, sickness had made me under 100 lbs which made me too scrawny. After working out I'd crave things like a hamburger, something I never ate before. Plus, not only are you hungry after working out or hiking or biking all day, but you feel like you deserve it and might splurge more than you would normally, so I could easily see gaining weight that way.
I'm losing too much weight again, and I am a vegetarian now (not because I want to be). So I should basically just load up on potatoes?
I'm curious about the sugars, I've cut out all high fructose corn syrup and have definitely felt a (good) change in my body. I assume "sugars" means real sugar though?
Stacy at August 15, 2009 5:19 AM
it's not as though one can make a blanket statement that eating carbs = obesity.
Actually, it is. And one can.
It won't make everyone obese. People do vary, and some can eat more carbs than others. But, the insulin explanation above is quite simple. And quite right.
Also, I can't tell you what a pleasure it is to not feel the pangs of hunger I would when I ate carbs. I just had my bacon for breakfast -- two strips -- and I'll have my cheese omelet, cooked in butter, very soon. And that will keep me going for hours. Once, when I was still eating bread, etc., I had a muffin at Starbucks -- and even worse, it turned out to be a lowfat (meaning fat replaced with sugar) one. I was ragingly hungry in about 20 minutes -- in a way I hadn't felt in a long time. Angry-hungry. "Get the hell out of my way" hungry. Horrible.
Amy Alkon at August 15, 2009 6:50 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1662979">comment from Clarewho read your post and are seriously considering going low-carb, because that lifestyle only works for non-athletes.
Actually, that's not true, and Eades makes that point (and backs it up) -- either in his book or on his website, can't recall which.
Amy Alkon at August 15, 2009 6:58 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1662982">comment from Amy AlkonRegarding exercise, from the Eades' book, page 281, hardcover: "Beyond a minute or two, the muscles, if they're to continue their work, must turn to the burning of either carbohydrate (stored within the muscle as a substance called glycogen, or muscle starch) or fat to fuel ongoing energy needs. Research has shown that the muscle would prefer to burn fat or the breakdown products of fat for fuel, because, among other reasons, the burning of carbohydrate for energy can quickly lead to the buildup of lactic acid within the muscle in the aerobically unfit. In fat, when even the aerobically fit reach their point of muscle fatigue, it's the buildup of lactic acid from burning sugar that finally makes the muscle scream, 'Enough already!' and quit."
The problem is, many people think they're dietary experts based on what they've heard for years all over the place. And people like Taubes and the Eades have looked hard at the research and seen that the emperor is naked and blubbery.
Amy Alkon at August 15, 2009 7:18 AM
Those of you who think that carbs are the be-all and end-all of life need to spend some time at a GNC. The only high-carb stuff they sell is for people who do very serious workouts.
And that's because you need to replenish the glycogen stores in muscle after an extreme workout because the muscles burned their stores up - which is something that won't happen under normal physical exertion.
brian at August 15, 2009 8:09 AM
I'm against a fat tax and in favor of an individual market for health insurance. This way the mutuals or for-profit insurers could offer you inclusion in certain pools based on factors like BMI. If you didn't like what they offered, you could shop around or change your diet. Let it be a marketplace.
Tyler at August 15, 2009 8:40 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1662997">comment from TylerI'm against a fat tax and in favor of an individual market for health insurance. This way the mutuals or for-profit insurers could offer you inclusion in certain pools based on factors like BMI. If you didn't like what they offered, you could shop around or change your diet. Let it be a marketplace.
I don't want a fat tax -- I'd like to see insurers charge obese people and people who are smokers more for their health insurance. Or you can call it giving a discount to people who are not obese and are non-smokers.
Amy Alkon at August 15, 2009 9:11 AM
Cigarettes I get, even alcohol, but fat? Maybe not so much. My Mom had PCOS and suffered through obesity for most of her adult life. It wasn't until she was older that they discovered what would help people with her disorder--namely a low carb diet and diabetic drugs like Metformin to improve insulin resistance. She'll never be slender but her weight has much improved.
There are many people like her though that can subsist on less than 1200 calories per day and still not lose weight. Not every overweight person is a lazy slob. And unlike cigarettes and alcohol, which a person doesn't have to buy, a person who has eating issues has to confront food at least three times per day, for the rest of their life. As someone who has an eating disorder, confronting and dealing with that every day is exceedingly hard and one of the reasons it is so hard to overcome.
What's next? Are we going to start screening women for potential breast cancer and charging them more? Or other disorders? Those who suffer from depression?
As an aside though, I began working with a nutritionist several years ago and one of the things she advocated was protein--especially in the morning, stop consuming diet drinks (i.e., diet soda, Crystal Lite, etc.) unless you're having a meal, more water, very limited fat-free or sugar-free foods, and more whole foods. And it works--our entire family eats that way now.
Sarah at August 15, 2009 9:16 AM
Amy -
They already charge more for smokers, at least in individual plans where they're allowed to.
And since they ask about alcohol consumption, I'm going to guess that drunks pay more too.
Oh, and they charge more for chronic allergies.
brian at August 15, 2009 9:21 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1663004">comment from SarahPer what Taubes and Eades write about exercise, it's not that people are lazy slobs. There are some people who will not be rail thin, but how many people have metabolical conditions? Most are just eating what they've been told by the medical establishment -- a diet which is not based in evidence-based science. It's sad. I think about all the years I dieted and faithfully ate a lowfat diet. These days, I eat almost no carbs and I'm rarely hungry, and I barely exercise and I don't get fat...in fact, I'm rail-thin since starting to eat this way. Plus, as Taubes points out, you aren't going to binge on protein-rich food like steak. When you're full, you don't keep packing it away -- as you do with carbohydrates. I keep recommending his book -- and now Eades -- because people need to know that they're suffering needlessly on these low-fat, high carb diets, and negatively affecting their overall health.
Amy Alkon at August 15, 2009 9:28 AM
Wait a minute - didn't The Goddess just recently trash "lifestyle medicine" as worthless?
Now she's saying that lifestyle DOES have significant impact on health.
Explanation please.
Ben-David at August 15, 2009 11:13 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1663018">comment from Ben-DavidI don't know what "lifestyle" medicine is. Obesity and smoking tend to be very detrimental to health.
Amy Alkon at August 15, 2009 12:02 PM
A recent article in Health Affairs estimated its annual cos"A recent article in Health Affairs estimated the annual cost from obesity to be $147 billion and growing. That translates into $1,250 per household, mostly in taxes and insurance premiums."
How was this estimated? Is this fact, or a biased interpretation? Is this the total cost of treating diabetes, or the estimated excess cost due to weight gain?
How do taxes fit in; do they mean extra public spending to treat weight related illness?
How does insurance premium fit in; does this mean that fat people are already paying for the results of their indulgences? If so, why should I care much?
t to be $147 billion and growing. That translates into $1,250 per household, mostly in taxes and insurance premiums.
Andrew_M_Garland at August 15, 2009 12:04 PM
(Sorry. I garbled that comment post. Here it is again.)
"A recent article in Health Affairs estimated the annual cost from obesity to be $147 billion and growing. That translates into $1,250 per household, mostly in taxes and insurance premiums."
How was this estimated? Is this fact, or a biased interpretation? Is this the total cost of treating diabetes, or the estimated excess cost due to weight gain?
How do taxes fit in; do they mean extra public spending to treat weight related illness?
How does insurance premium fit in; does this mean that fat people are already paying for the results of their indulgences? If so, why should I care much?
Andrew_M_Garland at August 15, 2009 12:06 PM
How was this estimated? Is this fact, or a biased interpretation?
As a rule of thumb, you should assume that all statements by Public Health officials and institutions are lies. That doesn't mean that everything they claim is a lie, but they'll inevitably misrepresent the facts a/o significance of any issue in order to manipulate public behavior. That's what Public Health is - a form of institutionalized health advocacy that masquerades as an empirical discipline.
As to your question of how they'd come-up with that number - http://content.healthaffairs.org/cgi/content/short/hlthaff.28.5.w822
Notice that the figure they promote is the highest of a range of estimates, based on projections based on earlier estimates of possible costs - i.e. they're making it up.
J.L.Seagull at August 15, 2009 12:33 PM
I both agree and disagree with Amy here.
You don't become obese by eating a slice of bread each day. Nor do you become obese by eating a bowl of ice cream. If you consume 4,000 calories a day and sit around and do nothing you will eventually become obese. It really doesn't matter how many carbs you ingest or how much protein you ingest. It is simply too much caloric intake for the amount of physical activity you do. So this is where I tend to disagree with the stance Amy takes. Cut back on your calories and you will lose weight.
Now - once you have left the land of obesity there is the fine tuning that must happen. This is where usual diets fail and Amys point becomes more valid. Once you learn to consume the appropriate amount of calories, you have to fine tune your diet to consume the proper types of calories. This is where the low glycemic index diet comes into play. Keeping you blood sugar at a stable level is important for those who leave a sedentary life. More active people have different requirements and should adjust for that i.e. I eat a bowl of pasta before a marathon to raise my blood sugar and give me enough energy to complete it. Body builders cut out ALL carbs for days before a competition so that they lose all leftover fat and appear "ripped" for the competition. They are totally exausted all of the time though because NO carbs is unsustainable in the long term.
karen at August 15, 2009 12:37 PM
Amy, you're trying to have too much fun being skinny. The numbers, the sheer weight, is literally against seeing any policy changes like this.
As with marriage and gay marriage and religion and a dozen other topics, people believe government should never constrain us or ask us to be strong.
Crid [CridComment @ gmail] at August 15, 2009 12:49 PM
"I don't want a fat tax -- I'd like to see insurers charge obese people and people who are smokers more for their health insurance. Or you can call it giving a discount to people who are not obese and are non-smokers."
I'm surprised that a self-identified libertarian wants government, or insurance, to do any of these things.
"Insurance" - n. - code word in the late 20th and early 21st centuries used to get many people to pay for the misfortune of individuals; misused to get benefits for individuals after life-changing, sometimes chronic mistakes committed in full view of wanrings against the behavior.
If YOU pay, YOU get to make your choices. And there is no reason whatsoever for you to pay when you do not receive any services. There is no reason for you to pay a government or insurance agent for routine care. There is no reason to pay thousands of people in administrative positions to explain what your benefits are in routine care.
Radwaste at August 15, 2009 12:57 PM
You already get a discount if you don't smoke.
Don't you know that smokers pay more for health insurance already?
Fat/obese would be tougher because you'd have to define what it means first.
Jaynie59 at August 15, 2009 1:21 PM
Of COURSE walking tubs of lard burn more calories...they're CARRYING more, than someone who does the same level of activity.
The fact is that it is that same fat person in the store who sees something that says "1/3 less fat!" and decides..."oh wow, I'll have 4 of them!"
Diet/shmiet, its not that bloody complicated.
Stop drinking 4 sodas a day, each of which has 12-32 grams of SUGAR, and calorie counts that average 100+ dependent upon size.
At a 2 for $2 deal at a fast food place...gee...order only ONE of whatever it is.
Oh...and how about just not GOING to a fast food place...god forbid one should bring a tuna sandwich to work from instead of waddling over to a fast food place and getting a slize of pizza with so much grease on it that its damned near a fire hazard.
Bread won't make you fat, hell a big rare & bloody 14 oz steak won't make you fat.
What'll make one fat is the CONSTANT snacking, CONSTANT consumption, drinks, bags of chips, little things of cookies from vending machines, then going out to lunch and eating a meal...as if one wasn't chowing down or drinking up for most of the few hours before hand.
I see this crap all the time.
Person: I don't understand it, I do physical training twice a day, how am I getting fatter?!
Person 2: Dude, I know, me to, we need to cut back on (name the blamed food component of the month), then we'll be fine.
Person 3: (Observing them chug down and toss an empty can of their 4th 200 calorie 32 gram of sugar energy drink or soda, then pull out mini bag of chips and sip their venti (extra large) smoothie from Starbucks)
C'mon people, a little common sense here. I'm not saying I doubt the science regarding insulin production as related to fat growth...but its all just so much hooey if you just sit back for a day, enjoy a pint of blue berries as a snack, and watch what overweight people DO without their even about it.
Robert at August 15, 2009 3:21 PM
Should have read: Without their even THINKING about it.
robert at August 15, 2009 3:26 PM
Reader: "it's not as though one can make a blanket statement that eating carbs = obesity."
Ms. Alkon: "Actually, it is. And one can."
Um, no, I must disagree with the hostess. {/duck thrown cutlery} If you work out hard, you need carbs from things like oatmeal, vegetables, fruits and other such sources. You also need protein, lots of it. That said, if you are mowing down chocolate-covered, deep-fat-fried bagels, don't be surprised at any weight gain, even if you do work out. The body quickly realizes those calories are empty and wants more to fulfill its nutrition demands. And. you. will. comply. But this concept that "carbs-is-carbs-is-carbs-and-all-carbs-are-alike" is wrong. Steamed, buttered broccoli does not equal a diet coke. Oatmeal is not chocolate cake.
Also, working out *hard* despite a scarcity of readily-available calories was how mankind lived back in the first 99% of our existence, and as such we were designed to be omnivores, not carnivores. We needed calories from any number of natural sources--including fruits and vegetables--whenever we were lucky enough to find them. And when we did find them, we ate all we possibly could. Who knew when the next meal was coming?
But our lifestyle now allows people to go their entire lives without ever really exerting themselves. (No, that junior high gym class was not real exertion, folks. Sorry.) Added to that, we have pretty much an endless supply of calories available to us. And we wonder why our bodies are so out of whack? Imagine keeping a thoroughbred in the stall every day, and then wondering why it seems to be so high-strung, screwed-up and fat after a decade of imprisonment and endless food. Baby, as that awful singer from New Jersey said, we really were born to run (and lift, and carry, and reach, and push, and...).
People can and should stay pretty close to their normal weight achieved in their late teens and early twenties, assuming they are active and fit teens at that time. It just takes a combination of LIFETIME (1) exercise and (2) attention to diet.
Our diet should follow this basic outline: if it is not pulled directly from a tree, dug directly from the ground, killed with a knife, or pulled from the udder of a beast, it is probably not food, no matter what they tell you. Food comes from nature, and is easily recognizable as such. If you rip open a package or tin can to get to food, it likely ain't food--it is, instead, a food-like substance, carrying calories, but stripped of nutritional benefits. I heard one person phrase the matter as if your great-great-grandmother would not recognize it as food, it ain't food.
If you followed that rule, how much of the food in your cupboards would have to be thrown away? For most Americans, it would be the majority of food in their house, I wager.
Finally, to all those "it's glandular!" apologists for the overweight, no, I'm sorry. It is not glandular, it is chemistry and physics. No one, anywhere, can gain weight unless calories consumed > calories burned. No one, anywhere can prevent losing weight if calories burned > calories consumed.
You can make all the rationalizations about eating disorders (it is a sickness why I eat those things! /stamp foot) or some such, but in the end, just like a heroin addict or a smoker has to accept that they are the ones doing this to themselves, the person claiming some sort of addiction to food must accept that not any other force in the entire universe is putting that food into their fleshy lips. They are. They are. They are.
As such, they hold the keys to their own prison at all times. Period. It is not the tobacco companies' fault people smoke. It is not the heroin dealers' fault people shoot up. It is not Krispy Kreme's fault people are overweight.
Spartee at August 15, 2009 3:48 PM
I lost 25 pounds. More exercise, less food overall, and somewhat fewer carbs. The trick is to convince yourself that feeling a bit hungry while waiting to eat something later is a GOOD thing -- it's the feeling of getting skinnier! Don't have a burger or tacos for lunch; have a small handful of almonds and some dried cranberries when you start to lag. You will feel hungry by dinner, but no hungrier than if you had the big calorie-gobble at lunch.
If only good red wine wasn't so fattening!!
Jay R at August 15, 2009 3:58 PM
Good post, Spartee!
Feebie at August 15, 2009 4:00 PM
Right now at just under 6'0 even, I weigh 214 lbs, which is heavy for my size, overweight according to the army. However my body fast percentage is very low, and my muscle mass is very high.
Let me say this.
If you want to lose weight, change your diet.
If you want to get stronger, change your lifestyle.
I eat voraciously, but I also bicycle 9 miles per day, run 4 miles 3 times per week, and lift weights twice per day minimum.
The bicycling is done to get me to and from work in the morning & the evening.
The running is mandated by my unit's physical fitness regs.
The lifting and other exercises I just do because I enjoy the sensations and the fit energetic feeling I get, and the ease with which I have since made otherwise profoundly difficult physical labors.
If you exercise, you will lose FAT. You will NOT lose weight, you will BUILD MUSCLE, and in case you are not aware of this...muscle weighs MORE than fat. Like the difference between stone and cookie dough.
So folks, pick up blueberries & blackberries en route to work, bring a tuna sandwich from home for lunch, and then in your off time, pump some iron. You'll lose fat, build muscle, and be easier for everybody to look at...to whomever that may apply.
Robert at August 15, 2009 5:02 PM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1663057">comment from karenYou don't become obese by eating a slice of bread each day. Nor do you become obese by eating a bowl of ice cream. If you consume 4,000 calories a day and sit around and do nothing you will eventually become obese. It really doesn't matter how many carbs you ingest or how much protein you ingest. It is simply too much caloric intake for the amount of physical activity you do. So this is where I tend to disagree with the stance Amy takes. Cut back on your calories and you will lose weight.
karen, you're disagreeing out of your own speculation. A calorie is not a calorie is not a calorie -- a point made by Taubes, based on the actual evidence, in his book. Also, bread will not make some people fat, but it will make others fat. Note the insulin reaction. I don't have to watch my caloric intake because I do not eat bread. You can't keep eating hamburgers the way you can carbohydrates. Again, you aren't disagreeing with me -- you have a point of view that is not evidence-based, and you're stating it. It isn't my "opinion" I'm stating -- I'm just restating what Taubes and Eades have shown the evidence says.
Amy Alkon at August 15, 2009 6:35 PM
Amy, you are failing to take into account the fact that nutrition research is constantly changing and highly susceptible to interpretation. For every book that you find that agrees with your conclusion, there is a book by someone equally reputable that doesn't. What we are trying to say is that some people, such as marathoners, can eat lots of carbs and be rail-thin; therefore, eating carbs does not alone equal obesity. You disagreed with me on that point above, but it is simply a fact that endurance athletes can maintain very low body fat on high-carb (60% total caloric intake) diets. If you need evidence, look at who's toeing the line at any race.
I think a truer thing to say is that eating an outrageous amount of calories, particularly the refined carbs (and saturated fat) typical in an American diet, can cause blood sugar issues that lead to increased obesity and hunger. That is a valid point. But saying that eating carbs will make you fat is a gross oversimplification and not true for everyone. I understand that you want people to know that protein and fat are more satiating than carbs, but it is straight-up incorrect to say that people get fat just from consuming bread.
Clare at August 15, 2009 7:36 PM
Wow, where'd you get your medical degree Spartee?
I've watched my Mom deal with PCOS and it is a hormonal problem due to insulin resistance produced by your body. My Mom's doctor put her on a diet of 1,200 calories per day--which she adhered to faithfully for months and lost next to nothing--about 2 pounds in 4 months. Then she gained.
It wasn't until later, that her diet was changed to mostly protein and she was put on Metformin to improve her resistance to insulin that she began losing weight.
And it's very easy to say "poo-poo" on eating disorders when you don't have one or know someone personally who is effected by it. Like I said, someone addicted to smoking or alcohol doesn't have to purchase those items and to a large extent can control their environment. Those of us who do have to deal with it have to confront food three times per day for the rest of our lives. It's incredibly difficult and extremely hard.
Add in the fact that ALL overweight people are perceived by most of mainstream society and the media as simply overweight slobs who would rather reach for a doughnut rather than a carrot stick and life gets really fun for those of us who choose to go the other way because we see how the ignorant and small-minded treat people close to us who do have weight problems.
It's great that you don't have a weight problem, but your staggering lack of empathy and compassion is, frankly, astounding--sadly, not surprising though.
Sarah at August 15, 2009 7:48 PM
This shouldn't even be controversial. Life insurance plans already discount (or charge more) for all these factors. Why not health insurance too?
kishke at August 15, 2009 8:51 PM
Well, in light of Sarah's post, I would say this is now a full on food fight, not a discussion.
Thank you, thank you, I am here all week! Try the veal...soaked in oil...no dinner roll.
Spartee at August 15, 2009 9:36 PM
> your staggering lack of empathy
> and compassion is, frankly,
> astounding
And you hate being frank, right?
Y'know, I like the big 'uns... Well, at least as much as the small ones. And there's more to life than reducing healthcare costs.
One of my favorite jokes is that fat women are only good for two things, sex and conversation... Because it's true that the conversation is distinctively feminine.
That can be a good thing, or a bad thing, like a drink with high-alcohol content: Good spirits, or cheap wine?
Sometimes the extra emotional energy that big women carry is disheartening: It's all about how other people done them wrong, and how the rest of the world is insufficiently supportive and interested. (And "compassionate".) The emotional machinery is so ravenous for sustaining fluids that it drains the souls of those nearby.
(And it, the Big Girl Machinery, attends Yanni and John Tesh concerts– Y'know, music for people who don't like music but who still want to participate in the consumer economy.)
But when women have their boundaries in order, they're fun at most every size.
BTW, men's character doesn't seem to change with weight this way.
Crid [CridComment @ gmail] at August 16, 2009 12:49 AM
I just dont think exercise is as important. I have been to parts of Asia (folks are size 0) and have never really seen gyms (quite unlike here in Cali). Granted folks walk everywhere but I think it has to do with food. It's fucking delicious, unlike the crap I have to put up with here. I never see people overeat either. I just dont think Americans in general know how to prepare food. The restaurants are horrible, unless you know where to go. It isnt the case in Asia.
When my mom ruled my diet as a kid I was never obease. In fact I couldnt ever gain weight, even though I tried. Her main thing has always been no junk food, no sodas, no sugars, no cookies, brownies, cakes. And I must admit her preparation of food was always outstanding. I can rarely find anything as good. She taught me to eat everything that's healthy, and it's something I dont see in my American counterparts.
I love this country but the food sucks.
Ppen at August 16, 2009 1:00 AM
"BTW, men's character doesn't seem to change with weight this way."
Because how much people like you at first sight doest really change for men with weight.
I know that I have seen some young women who are obease and been disgusted. I havent ever had the same reaction with men.
Ppen at August 16, 2009 1:07 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1663075">comment from ClareAmy, you are failing to take into account the fact that nutrition research is constantly changing and highly susceptible to interpretation.
Actually, Taubes found that nutrition research from the past was right on -- and the insulin reaction I wrote about (referencing his research of the research) isn't "changing." That's just a non-evidence-based attempt to whittle down the actual science in to the bullshit put out by so many doctors and "nutritionists."
Clare, I'm really utterly uninterested in your opinion, because it's mere opinion, based on received ideas that are not based in science. Taubes is a skeptic's skeptic, who studied physics, and I know him, and I would describe him as utterly tortured about being sure he's putting out the evidence-based truth. In fact, it's pretty much his mission.
Read his book, then see if you can still quack like you are above.
Amy Alkon at August 16, 2009 1:23 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1663076">comment from Clareparticularly the refined carbs (and saturated fat)
Clare, Clare, Clare...how can you be so comfortable just tap-tap-tapping out your mere opinion? Based on what, what you've been told, an article you read in Self?
http://www.nasw.org/awards/2001/01Taubesarticle1.htm
Taubes has now won this award -- the top award for science writing -- so many times that he's no longer eligible (they want to give somebody else a shot).
Here's a bit from the sidebar:
You take the sprout sandwich, dear. I'll have that steak -- just like I did for dinner tonight at a BBQ. (To quote Fran Lebowitz, "My favorite animal is steak.")
This is just Taubes' 2001 article. I suggest you read his later book, linked above, and his NYT piece, before you spout off any further. Eades' work, too.
Amy Alkon at August 16, 2009 1:34 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1663077">comment from SparteeNor is Spartee's response based in science, but I have to go to bed. Human bodies evolved at a time when oats were not a food source. When I interviewed Taubes a few years back, he told me that meat has every vitamin humans need but vitamin C -- in the correct proportion, unlike vegetarian diets. There are societies -- or were -- that subsist on meat or mostly meat alone (I believe the Inuit did). Please read these books -- get the out of the library if you have to -- all of you who are wantonly spraying your received, non-evidence-based "wisdom" about what to eat. Go read Eades' blog. The guy knows a thing or two. I've been corresponding with him a bit, about diet and science, and I'm impressed. And I'm not easily impressed.
More on the vitamin C here:
http://www.carnivorehealth.com/main/2009/6/3/disease-of-civilization-scurvy-vitamin-c-deficiency.html
Amy Alkon at August 16, 2009 1:40 AM
When I interviewed Taubes a few years back, he told me that meat has every vitamin humans need but vitamin C
And in his book he cites possible evidence that vitamin C is not needed by meat-eaters; it's needed only to correct the deficiency in plant-based diets.
kishke at August 16, 2009 7:02 AM
I just purchased Taubes' book through the Amazon link above. I've struggled with my weight for a long time. It kind of sounds like Atkin's, from the brief explainations on here, which scares me.
Just curious Amy, is your cholesterol high? I'm excited to read the book and hopefully become enlightened. I do work out and don't plan on stopping because I enjoy it (tennis and swimming), so hopefully that isn't an issue!
Casey at August 16, 2009 9:05 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1663109">comment from CaseyThanks, Casey, and so glad you did. And no, my cholesterol isn't high, but the chain of evidence for high cholesterol causing heart disease just isn't there.
http://www.nytimes.com/2008/01/27/opinion/27taubes.html
Amy Alkon at August 16, 2009 9:19 AM
I haven't read Taube's book, but I did just read Taube's and Eade's articles, and everything makes sense and seems to be soundly medically substantiated. That being said, I could never eat like you do Amy, because 1) I'm a vegetarian (I do eat fish), 2) I don't particularly like most dairy products, a lot of butter, or anything greasy and 3) I love fresh fruits and vegetables and will never give them up, although I avoid the starchier ones. I'm not going to force myself to spend the rest of my life eating foods that I find repulsive when a low-starch, vegetarian diet combined with an active lifestyle works just fine for me.
The thing is, diets don't work in the long run-healthy lifestyles do. The best "diet" for any given person is the one that they can live by for the rest of their lives. Amy, it's great that Taube's no-carb, high-fat lifestyle is working for you, but that doesn't mean that it's the best diet for everyone, or the only way to lose weight. Millions of people have lost weight or maintain a healthy weight with other diet plans. It doesn't take a medical degree to figure out what works for you, and if you've found a eating style that works and is keeping you thin (like Robert, Jay R, Karen, and Clare), then why rock the boat?
Shannon at August 16, 2009 10:35 AM
Whether you eat nothing but white bread, or nothing but eggs, too much makes you fat. Where carbs come in is the insulin surge gets the sugar out of your blood quicker, making you feel hungry faster, so you eat more. If you counted the calories and only ate what you burned, carbs wouldn't hurt you. Protein and fat just don't let you feel hungry as quick as there is no insulin surge.
IN the end, all it is is eat what you burn, no more. Of anything. 2 strips of bacon really doesn't have that many calories, nor do eggs. They do have the protein to keep you full longer. So you're not really eating so much, Amy, but it lasts longer.
momof4 at August 16, 2009 1:38 PM
Atkins was right, which is why the dieticians and nutritionists hated him so much.
I can tell you that when I did the Atkins diet, I never felt better - physically, mentally, emotionally.
However, if you follow the phases, you're supposed to get yourself to a new way of eating. I was unable to make that adjustment - I like sweets far too much.
I'm learning to control the sizes of things so I can eat the things I want. The weight's trending in the right direction again, and now I don't feel deprived and I don't have the cravings which would lead to me binging on the worst possible foods.
Basically, if you want to be healthy, eat like an ape.
Oh, and regardless of what people tell you, exercise is good for you in a number of other ways even if it increases appetite. Joint and muscle health are only maintained through exercise and use.
brian at August 16, 2009 6:33 PM
Bone density, too. You have to stress your bones, or lose them. Jumping is a great way to do that, running, lifting heavy weights. Just walking won't cut it.
momof4 at August 16, 2009 6:37 PM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/15/health_insuranc_3.html#comment-1663196">comment from brianOh, and regardless of what people tell you, exercise is good for you in a number of other ways even if it increases appetite. Joint and muscle health are only maintained through exercise and use.
I try to do 60 minutes on the bike a week (a bike with arm thingies you have to push), and I do weight bearing exercise, and stand on one foot for 15 seconds and then the other while I'm mixing my eggs. The epidemiologist I'm friends with told me weight-bearing exercise and that latter exercise are important (in terms of healthy aging). The latter is apparently to help you maintain balance in old age. At first, I could barely stand on one foot without moving around. Now, I can stand for a while -- much longer than 15 seconds on each. The next step is to be able to do it with your eyes closed. Have to start doing that, too.
And as far as the weights go, they're by my TV. I'll pick them up and do 20 reps this way or that way.
Eades passage in his book on exercise vis a vis what likely was the case (in exertion) in ancestral times is very interesting. Sorry to leave it at that, but I am so snowed with stuff to do right now, it's a little scary!
Amy Alkon at August 16, 2009 6:58 PM
What I meant by Atkin's being scary is the complete lack of carbs. I also searched around on the internet after I ordered the Taubes book and apparently it is pretty 'dense' to read. I'm excited to give it a try though, but I'm already sold from what Amy has said, so I hope it outlines what I should eat pretty simply!
Casey at August 16, 2009 8:13 PM
The complete lack of carbs never happens in Atkins.
During "induction" which puts your body into the mode where it burns fat for energy, you limit yourself to 20g of carbohydrate a day, and none of it from grain or nuts.
After that, you limit it to differing amounts, but you are supposed to get your carbs from salads, low-sugar vegetables, nuts.
A total lack of carbs is not healthy. It's also not how ancient man ate - meat, nuts, berries. We didn't grow up eating grains and processed sugars. And we don't run around the savannah chasing down dinner every day either.
brian at August 16, 2009 8:55 PM
First of all, thanks Amy for recommending Taubes' book. I finished it a few weeks ago and thought it was brilliant.
Second, reading that book has reinforced my belief in the Atkins Diet. I went on it in 2002 on the advice of my doctor, and lost 60 lbs. Then, around 2004, I went off (I blame carb-creep which, unchecked, leads to the vicious carb cycle of feeling starved all the time and eating more carbs, etc.) and gained it all back. Taubes' book made me realize how much better the Atkins diet was for me, and I started back on it about a month ago. I am now steadily losing about 2 lbs. a week, and feeling better than I have in the last 5 years. Also, when I was on Atkins the first time, my cholesterol and blood pressure were excellent, so no, eating all meat will not kill you. I have a very low carb tolerance (20 grams a day is about my max for weight maintenance) and while I do know people that can tolerate much more, I can't.
I think I will go have a steak now. :D
Ann at August 17, 2009 8:12 AM
"Add in the fact that ALL overweight people are perceived by most of mainstream society and the media as simply overweight slobs who would rather reach for a doughnut rather than a carrot stick"
There is such a thing as to much empathy, to much compassion.
I have little to none of either because there is at present, to my mind at least, FAR TO MUCH of the former.
If a person stabs themselves intentionally, should I feel sorry for their pain?
Of course not. Do not pity bad judgement.
Similarly, why should I have empathy for people who do not develop self control?
There are chemical addictions certainly, which make it difficult to escape the tempting substance.
But some of the comparisons...say of food to crack...those are just so much self pitying excuses.
Most of the time, "eating disorder" is the same as "lack of willpower".
The aforementioned stereotype...well um, duh. Look inside a fast food restaurant, walk down cubicle aisles. What do you see?
The people who cannot see their toes are either constantly snacking or drinking sugary crap, and or ordering & eating the worst possible items.
Oh wow...confronted by food 3 times per day? Not true, we're CONSTANTLY confronted by food. What large company doesn't have vending machines, fridges, and when is there ever a time that coffee shops & fast food places are all closed?
BUT, the mere existance of these options does not mandate their indulgance. If those suffering from so called "eating disorders" were suddenly bereft of the funds necessary to indulge their habits, would they rob or kill to support their sugar & fat "addictions". Of course not, they'd just do without. If it were truly "beyond their control" then like the desperate addict that will do anything to shoot up one more time...well my point is made.
Argue it if you'd like
Robert at August 17, 2009 9:39 AM
Shannon, I’m a vegetarian too (and have also started eating fish and seafood, to get more protein) and I found a book that you might enjoy if you’re interested in doing a low-carb diet/lifestyle. It is The Low-Carb Vegetarian Diet by Rose Elliot. I know you didn’t really say you were interested, but in case you are, I thought I would mention it. It has a pretty comprehensive list of the carb content of fruits, veggies and vegetarian protein sources, so you could keep track of how many you’d be getting in a given day, and it has a bunch of recipes, and I think a month long menu suggestion in it… I thought it was pretty awesome because I can’t tell you how sick of eggs I am! I know there are other books out there too, but I only have this one, and I thought it was worth passing along.
Angie at August 17, 2009 11:30 AM
Vegetarians who eat fish (which means you aren't really vegetarians, but I understand that it's easier to give a one word description of your preferred diet), would you mind explaining why seafood is different for you than other animals? I'm not being snarky, it's just something that has always confused me. Do you not like meat, but think fish is OK? That would make sense, I just get confused when people object morally to eating meat but for some reason fish are exempt . . .
Sam at August 17, 2009 1:47 PM
Sam, yeah, people usually get confused if you call yourself a pescatarian, which is the usual term for people who abstain from all meat except fish. I’ve actually answered this question in an earlier thread, and it was rather long and drawn-out, so I’ll try to paraphrase here. While I can’t speak for all people who make this choice, for me, it’s because I’ve had certain health issues in the past that have required me to get more protein than I was getting, and I was forced as a teenage vegetarian, by my mom, to at least eat fish. I did stop for a number of years, and actually really never liked the taste of fish, but have recently started having it here and there (and actually I really only have shrimp, because I still don’t really like fish, but I’ll eat salmon and tuna on occasion) because I wanted to do the low-carb diet after reading about how much better it is for your health.
Also, I want to point out that abstaining from meat isn’t always a moral issue, which seems to be the basis of your confusion. I stopped eating meat because I went on vacation to Ireland with a friend and her family while I was a teen, and I ate burgers almost every day because to me, everything else was gross and weird. Then I had some chicken soup that about made me vomit, and my friend started clucking at me, and I made the choice then and there that it tasted like something died in my soup, and I couldn’t eat meat since. Of course, I do love animals, and not eating them makes me feel good about not causing their suffering, but I’m not some PETA freak out there condemning other people for their food choices. People eating animals doesn’t bother me, it’s when animals are forced to suffer for it that makes me sad and angry.
But again.. I’m bad at being concise, and this is already quite drawn-out, so I’m done!
Angie at August 18, 2009 11:00 AM
Leave a comment